Introduction: Yenadis are one the major tribe of Andhra Pradesh. They are special community people with low socioeconomic status (SES) and they do jobs like collecting trash from garbage for their livelihood. Their life style, livelihood practices may have an impact on their oral health. Aim: The aim was to assess the impact of SES on oral health related quality of life in yenadi's community. Materials and Methods: A total of 156 adults residing in Yenadi colony in Guntur city were interviewed with oral health impact profile-14 questionnaire which was translated to local language, followed by clinical examination for dentition status and periodontal status. Data from subjects who were missed on the day of examination were collected on consecutive days. Demographic details, oral hygiene practices and personal habit details were collected. Results: Sufficient reliability (0.8) and validity were demonstrated for questionnaire. The associated factors effecting quality of life are gender (P = 0.02), age (0.005), SES (0.001), oral hygiene aid (0.001) and personal habits (P = 0.001). The mean decay missing filled total value of the study subjects was 3.69 ± 2.4. Among the study subjects, 52.7% of study subjects had calculus, and 25.6% of study subjects had pockets >6 mm or more. Conclusion: This study revealed high level of oral disease and poor perception of oral health among the people residing in that area, which is due to lack of knowledge of existing problems.

Any disease that could interfere with the activities of daily life may have an adverse effect on the general quality of life. Much has been said and written about quality in recent years. It is the subjective component of wellbeing. Quality of life was defined by World Health Organisation (WHO) as "the condition of life resulting from the combination of the effects of the complete range of factors such as those determining health, happiness, education, social and intellectual attainments, freedom of action, justice and freedom of expression. [1]

Although dental diseases are rarely life-threatening it does influence the quality of life. Pain, fear, function and esthetics affect the life quality with chewing and eating problems being substantial concerns. Oral problems may influence the capacity of individuals to live comfortably. [2] According to Surgeon General's report oral health-related quality of life (OHRQoL) was defined as "a multidimensional construct that reflects people's comfort when eating, sleeping, and engaging in social interaction; their self-esteem; and their satisfaction with respect to their oral health". [3] It is important to understand how people perceive the impact of oral diseases on their quality of life. The concept to OHRQoL can be used for various purposes, including evaluation of people's need and their levels of satisfaction, evaluation of the results of intervention and human services programs, the planning and provision of these services, and the formulation of appropriate policies for the general population and specific subpopulations. [4]

Yenadis are one the major tribe of Andhra Pradesh. This community deserves special mentioning as they have gained acclamation in entrapping several animals like rats, snakes, etc. Apart from that they also do jobs like collecting trash from garbage for their livelihood. These people are socially disadvantaged with poor income and their lifestyle; livelihood practices may have an impact on their oral health.

Although many studies on OHRQoL and its associated factors in the adult population have been reported from India, none of the studies have addressed special community with low socioeconomic status (SES). Against this background, the aim of this study was to assess the impact of oral health on the quality of life and the associated factors affecting the OHRQoL among the adult population residing in Yenadi colony, Guntur city.

Materials and methods

A cross-sectional study was conducted from June 2011 to July 2011 among adults of Yenadi community that is located in south-east part of Guntur city, Andhra Pradesh State, India. A list of all the adults residing in Yenadi colony was obtained from the head of the colony. A total of 169 adults were residing in the colony out of which 156 accepted to participate. Thirteen subjects refused to participate in the study due to the fear of being examined by a dentist.

Data from subjects who were missed on the day of examination were collected on consecutive days. All the adults above 18 years, who are willing to participate in the study, were included by obtaining an informed consent and severely debilitated patients were excluded. Ethical clearance was obtained from the Ethical Committee.

Data collection

General information and information related to the subjects oral hygiene practices and habits were collected by interview. The present study was conducted by a single examiner and examiner calibration was done in the department of Public Health Dentistry. A set of autoclaved instruments was carried to the examination site. American Dental Association type III examination [5] were conducted using natural daylight, plain mouth mirror and probe for recording the Dentition status and treatment needs index, community periodontal index (CPI) and Loss of attachment index given by WHO. [6]

Along with clinical examination, all the subjects were interviewed with a pretested questionnaire that is oral health impact profile-14 (OHIP-14) [7] which was translated into local language (Telugu) and later back translated into English to adapt culturally and linguistically to local settings. Differences in the translation were resolved by discussion. The translated version was pretested on 20 subjects for its validity and reliability. Face validity of the instrument was assessed by observing their ease of use and by asking about difficulties in understanding items or frequencies. Internal consistency of OHIP-14 was evaluated with cronbach's alpha coefficient (α =0.8). Mann-Whitney U-test, Kruskal-Wallis tests and Spearman's correlation coefficient were used, and the data were analyzed using SPSS software V.15.0. (IBM, USA). A P < 0.05 was considered to be significant.

Results

From the sociodemographic point of view the sample composed of 82 men and 74 women with a mean age 37.4 ± 10.8 [Figure 1].

About 23.1% of study subjects belong to 35-39 years of age and only 3.8% belong to >55 years of age. Based on education study population was divided into 7 groups, out of which 85.9% are illiterates. In the present study, almost all of them belong to lower class.

Out of 156 study subjects 63 (40.4%) and 51 (32.6%) used twig and finger respectively as their oral hygiene aid. Males had multiple harmful habits out of which consuming alcohol (95%), gutkha (86.5%) and pan chewing (73.2%), and bidi smoking (69%) are predominant. Among females 65% had habit of pan and betel nut chewing. When assessed with Kruskal-Wallis one-way ANOVA, these habits have more impact on OHRQoL that is statistically significant (P = 0.001).

The mean decay missing filled total (DMFT) value of the study subjects was 3.69 ± 2.4 with decay being 2.70 ± 1.71, missing 2.63 ± 1.34 and filled 0. On an average, at least three permanent teeth required dental treatment such as fillings, crowns, endodontic treatment, and extractions.

Among the study subjects 52.7% had calculus, and 25.6% had pockets >6 mm or more.

The distribution of responses to the OHIP-14 items shows a high percentage of respondents scored high for painful aching in the mouth and uncomfortable to eat any food with mean scores 7.2 and 5.7, respectively.

Association between gender and OHRQoL was assessed using Mann-Whitney U-test which revealed that males experienced more impact on their quality of life due to oral conditions when compared to females and the association is statistically significant (P = 0.02) [Table 1].

Understanding the consequences of oral ill health from the patient's perspective has emerged as an important research area. This has resulted in an increase in use of patient-centered oral health status measures, predominantly seeking to measure the impact of oral health on quality of life.

In the present study, 52.6% are males, and 47.4% were females with mean age 37.4 ± 10.8. Most of the study populations are illiterates (85.9%) and only few had basic education. Almost all of them belong to lower class. The information regarding their usage of oral hygiene aids showed that 63 (40.4%) Yenadis used chew sticks, whereas 51 (32.6%) of them used finger with either salt or charcoal. Only 42 (26.9%) used toothbrush with either toothpaste or toothpowder, these findings are differing from the study done by Bhat and Kundankuppe [8] in which majority (79.8%) of them use chew sticks. In addition, they have adverse habits such as smoking, pan chewing, consuming alcohol both in males as well as females.

The mean DMFT score of the present study was 3.69 ± 2.71 which is in accordance to Bansal etal. [9] study and lower than other studies conducted by Kumar etal. [10] and Thaweboon etal. [11] in which the mean DMFT was 6.23 ± 5.4 and 6.53 ± 6.32, respectively. The present study showed almost all the people suffer from various forms of periodontal problems as assessed by CPI, which is in accordance to study conducted by Thaweboon etal. [11] and Kruger etal. [12] The major factors to explain these situations were the characteristics of the people and lifestyle.

Age, gender, SES, oral hygiene practices and habits had impact on quality of life which is differing from study conducted by Jayakumar etal. [13] Majority of study subjects reported painful aching in mouth and uncomfortable to eat any food, which is in accordance with the study conducted by Smith etal. [14] in which 88% of study subjects experienced painful aching in mouth. Based on clinical findings, it was observed that on average at least three permanent teeth required dental treatment such as fillings, crowns, endodontic treatment, and extractions which is similar to the study conducted by Sampaio etal. [15] and Phipps etal. [16]

Overall, the present study showed that adults living in Yenadi colony had higher levels of periodontal problems. Even though periodontal problems were a significant health problem faced by these people, oral health was generally perceived to be of lower importance than physical health. Scientifically validated data on dietary habits were not recorded for this population. Further research is required on this community for better understanding of their lifestyle, food habits and cultural practices, so that proper basic oral health care programs can be planned and implemented.

Recommendation

As oral health is an important part of everyone's well-being. Under the prevailing circumstances, the implementation of a basic oral health care program for the Yenadi community is a high priority.

Conclusion

This study revealed high level of oral disease and poor impact of oral health on their quality of life among the people residing in that. The quality of life affected only due to the presence of the painful condition in the mouth or inability to chew food. The associated factors effecting quality of life is gender, age, SES, oral hygiene aid and personal habits.

Locker D, Matear D, Stephens M, Lawrence H, Payne B. Comparison of the GOHAI and OHIP-14 as measures of the oral health-related quality of life of the elderly. Community Dent Oral Epidemiol 2001;29:373-81.

Jayakumar A, Dodhani K, Parthasarathy P, Haritha A. Oral health related quality of life in periodontal patients in India and rural population: Does it really impact and relevant to all types of population? J Indian Assoc Public Health Dent 2011;17:639-44.